One of the more illuminating remarks during the health-care debate in Congress came when House Speaker Nancy Pelosi told an audience that Democrats would “pass the bill so you can find out what’s in it, away from the fog of controversy.”

That remark captured the truth that, while many Americans have a vague sense that something bad is happening to their health care, few if any understand exactly what the law does.

To fill this vacuum, Representative Kevin Brady of Texas, the top House Republican on the Joint Economic Committee, asked his staff to prepare a study of the law, including a flow chart that illustrates how the major provisions will work.

In addition to capturing the massive expansion of government and the overwhelming complexity of new regulations and taxes, the chart portrays:

$569 billion in higher taxes;

$529 billion in cuts to Medicare;

swelling of the ranks of Medicaid by 16 million;

17 major insurance mandates; and

the creation of two new bureaucracies with powers to impose future rationing: the Patient-Centered Outcomes Research Institute and the Independent Payments Advisory Board.

Brady admits committee analysts could not fit the entire health care bill on one chart. "This portrays only about one-third of the complexity of the final bill. It’s actually worse than this."

The result, made public July 28, provides citizens with a preview of the impact the health-care overhaul will have on their lives. It’s a terrifying road map that shows Democrats have launched America on the most reckless policy experiment in its history, the economic equivalent of the Bay of Pigs invasion.

This clearly is a candidate for most disorganized organizational chart ever. It shows that the health system is complex, yes, but also ornate. The new law creates 68 grant programs, 47 bureaucratic entities, 29 demonstration or pilot programs, six regulatory systems, six compliance standards and two entitlements.

Getting that massive enterprise up and running will be next to impossible. So Democrats streamlined the process by granting Health and Human Services Secretary Kathleen Sebelius the authority to make judgments that can’t be challenged either administratively or through the courts.

This monarchical protection from challenges is extended as well to the development of new patient-care models under Obama’s controversial recess appointment, Donald Berwick, whom Republicans are calling the rationer-in-chief. Berwick will run the Centers for Medicare and Medicaid Services, where he can experiment with ways to use administrative fiat to move our system toward the socialized medicine of Europe, which he has at times embraced.

A sprawling, complex bureaucracy has been set up that will have almost absolute power to dictate terms for participating in the health-care system. That’s what the law does to government. What it does to you is worse.

Based on the administration’s own numbers, as many as 117 million people might have to change their health plans by 2013 as their employer-provided coverage loses its grandfathered status and becomes subject to the new Obamacare mandates.

Those mandates also might make your health care more expensive. The Congressional Budget Office predicts that premiums for a small number of families who buy their insurance privately will rise by as much as $2,100.

The central Obamacare mechanism for increasing insurance coverage is an expansion of the Medicaid program. Of the 30 million new people covered, 16 million will be enrolled in Medicaid. And you could end up in the program whether you want it or not. The bill states that people who apply for coverage through the new exchanges or who apply for premium-subsidy credits will automatically be enrolled in Medicaid if they qualify.

Hurting the Elderly

To pay for this expansion, the bill takes $529 billion from Medicare, with roughly 39 percent of the cut coming from the Medicare Advantage program. This represents a large transfer of resources, sacrificing the care of the elderly in order to increase the Medicaid rolls.

For all this supposed reform, you, the American taxpayer, can expect a bill to the tune of $569 billion.

Front and center among the new taxes is the 40 percent excise tax on those lucky people with so-called Cadillac health plans. The higher insurance costs that are driven by the government mandates will push many more ordinary plans into Cadillac territory.

If the idea of taxing people with coverage deemed too good doesn’t bother you, maybe the new 3.8 percent tax on investment income will. That will apply even to a small number of home sales, those that generate $250,000 in profit for an individual or $500,000 for a married couple.

In vivid color and detail, Congressman Brady’s chart captures the huge expansion of government coming under Obamacare. Harder to show on paper is the pain it will cause.

In my state (CA), we have a mandatory, state enforced requirement for auto insurance. If you register your car, you must show proof of insurance. If you get pulled over, you must show proof. If you can't afford it the state will provide it for you, and bill accordingly. This is because for many years we had very frequent occurences of uninsured motorists crashing into everything under the sun and then crying about how expensive insurance was and that they could not afford it.

Ultimately, it cost the rest of us more money in increased premiums. This was very clear to all and legislation was put in place mandating the coverage. I do not recall that there was a hue and cry of socialization or accusation of statism or totalitarianism.

People were more or less glad to have it, unless of course you were looking to dodge the monthly bill.

Now, I am no fan of the health care bill. It seems like a cleverly couched tax trojan horse, needlessly complex, and who wants that. But to the core issue of requiring coverage so that the costs are not externalized to the individuals that do have coverage, help me out here. The conservative right did not characterize this as a tax bill (until it was too late anyway) they characterized this as an affront to an idealogical position..

Just not sure how this idealogical viewpoint stands up, once the cuteness of claiming totalitarianism wears off. When are we as citizens going to stop allowing individuals and corporations (especially corporations) to externalize their costs on us, all the while claiming that for them to be held acountable for these costs is an affront to patriotism and is therefore government intervention?

In my state (CA), we have a mandatory, state enforced requirement for auto insurance. If you register your car, you must show proof of insurance. If you get pulled over, you must show proof. If you can't afford it the state will provide it for you, and bill accordingly. This is because for many years we had very frequent occurences of uninsured motorists crashing into everything under the sun and then crying about how expensive insurance was and that they could not afford it.

Ultimately, it cost the rest of us more money in increased premiums. This was very clear to all and legislation was put in place mandating the coverage. I do not recall that there was a hue and cry of socialization or accusation of statism or totalitarianism.

People were more or less glad to have it, unless of course you were looking to dodge the monthly bill.

Now, I am no fan of the health care bill. It seems like a cleverly couched tax trojan horse, needlessly complex, and who wants that. But to the core issue of requiring coverage so that the costs are not externalized to the individuals that do have coverage, help me out here. The conservative right did not characterize this as a tax bill (until it was too late anyway) they characterized this as an affront to an idealogical position..

Just not sure how this idealogical viewpoint stands up, once the cuteness of claiming totalitarianism wears off. When are we as citizens going to stop allowing individuals and corporations (especially corporations) to externalize their costs on us, all the while claiming that for them to be held acountable for these costs is an affront to patriotism and is therefore government intervention?

It's been said that "All analogies limp" but the analogy that compares auto insurance reqirements to Obamacare is an utter cripple.

In order for this comparison to have any traction the state of California would have to:

1)Mandate that all residents, not just drivers, must have insurance.

2) Sell auto insurance.

3) Become an advantaged competitor and drive insurance companies out of business as a result of 2) above.

3) Fund any program deficits from tax revenue.

4) Provide free auto insurance to those who are unable or unwilling to provide for themselves.

5) Raise rates on those who do buy auto insurance to pay for those who get a free ride, thus penalizing those who act responsibly

.....for starters.

The notion that we need Obamacare so as not to "externalize" costs is downright Orwellian because that's exactly what it does: Some individuals are enabled to "socialize" their living expenses at the expense of others through the use of government force (taxation, penalties and even incarceration, yes incarceration is in the bill!).

The contention that the taxation issue wasn't previously raised is ignorant of the facts. Obama was repeatedly challenged on this point during the process, and repeatedly he forcefully repudiated the notion that this was a tax , which makes it even more galling since he now defends against court challenges that question the constitutionality of forcing citizens to purchase a product, by citing the power of the Federal govt to tax. Hypocritical is an understatement.

It’s not clear that you understand that the State of California is currently doing ALL of the things mentioned in both of our posts with respect to auto insurance, with no deleterious effects. The state has a vibrant and vigorous private auto insurance sector that is not driven out of business by an advantaged state, and provides a (for pay) compliance level policy for those whose driving records prohibit them from seeking the lower cost private option. At no cost to the tax payer.

Your point 5 is precisely the argument I am making in externalizing the costs, I am not at all clear how this is somehow now presented as a disadvantage to the analogy. I’m not following your logic at all. To the point of requiring all residents and not just drivers to carry auto insurance, the operative principle is simple, those that use a service, pay. If you don’t drive or have an auto, why must the analogy consider these non actors as contributors to the system?

As I stated, I am not advocating Obama care, and I do not support the bill. No one said we “need” Obamacare on this thread, however, I once again do not understand your logic here claiming that in general, some type of requirement for universal health care coverage is Orwellian. This again is precisely the point I make, all this pseudo political posturing with oblique references to state control and totalitarianism obfuscates the relatively straightforward concept of expanding the insurance pool participants to those that require the services. Everyone will at some point require health care services. There is a normal (and very predictable) tendency for low and middle income families (or anyone on a fixed budget) to try and defer or ignore these (insurance) costs for a whole host of reasons. When they do occur, the only question is who is going to pay. I take exception to a concept and an ideology that externalizes these costs to those of us who do pay, those of us who are responsible, and as a result of this irresponsibility see dramatically increased rates.

This is not Obamacare.

This is directly analogous to the auto insurance situation in CA for the reasons I have just outlined. Many political experts have commented that the reason the conservative right failed in their efforts to derail the bill was the inordinate focus on the ideological differences, and the hysteria created around this ideological dissent. For example the infamous “death panel” propaganda initiative is an excellent example of the crap that was circulated by way of positioning ANY health care bill as an alternative to the status quo. Shocking as it may be, many people are deeply offended when mainstream political parties come out with such missives, and summarily dismiss subsequent objections as partisan, and well, just plain nutty. During the campaign, there was some mention by the right that there were taxes, but the vast majority of the anti-Obamacare platform and the fundamental political thrust was ideological and this (as now recognized by the party strategists) was a huge mistake.

A bill, ANY bill, positioned as primarily a tax increase initiative has about zero chance of making it through any legislative body. This was an enormous misjudgment by the conservative right, and the after the fact posturing around the (increasingly evident) tax increases is just too little-too late.

Chris Martenson had a blog a month or two back, and he opined that there are two types of people in the world, those that have to wait until they are hit by a train to react, and those who see the train coming and take action to avoid or at least mitigate the disaster. With respect to the subject of health care, the dominant philosophy was that there was no problem, no need to change, everything is just fine and dandy. Health care 16% of GDP and projected to hit 21% of GDP by 2015? No problem here, nothing to see here, just move along.

I don’t contend that Obamacare is the solution, but I can’t help thinking that if words like “Orwellian” “totalitarian” and “socialism” were used a little less frequently, and certain groups a little more cognizant of the accelerating realities of health care costs, we might have ended up with something a little more analogous to the insurance solution in CA- without all the taxes.

I don’t contend that Obamacare is the solution, but I can’t help thinking that if words like “Orwellian” “totalitarian” and “socialism” were used a little less frequently, and certain groups a little more cognizant of the accelerating realities of health care costs, we might have ended up with something a little more analogous to the insurance solution in CA- without all the taxes.

The 10th Amendment states....

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

If California wants to have state healthcare, there is nothing stoping it. After all Obama care is very similar to Massachusetts state run healthcare, except it is forced on the whole country.

For me, either we live in a constitutional republic with limited federal governmental powers, or we live in totalitarian system where the states and municipalities are little more than vassals of federal power. I want the former but it sounds like you and most people in Washington DC want the later.

Per capita expenditure on health care in the US is about twice that of Canada and the health outcomes are no better. I don't expect this measure to bring about any improvement since it does nothing to change the profit motive for health care.

A report on the financial condition of the Medicare and Social Security programs contends the Obama administration's sweeping health care overhaul will extend the life of the Medicare hospital insurance fund by 12 years — an assertion that Medicare's top numbers-cruncher disputed.

This report by the trusties indicates that they expect significant saving in the years ahead so that solvency of the medicare fund will be extended for an additional 12 years. When has health care ever cost less one year than the previous year? Never. Look at the data from the following table that gives numbers for total health care and it shows a steady increase in cost. Why does anyone believe that medicare will somehow cost less in succeeding years. I can't believe that rational people will actually believe this report about medicare.

Per capita expenditure on health care in the US is about twice that of Canada and the health outcomes are no better. I don't expect this measure to bring about any improvement since it does nothing to change the profit motive for health care.

When I look at that horrendous organizational chart in DrKrbyLuv's opening post, what I see is lack of accountability. If you are denied care, or unhappy with the quality of care, to whom do you complain? If you dislike the system and want to change it, how can you possibly dislodge that dense thicket of bureaucracy and overlapping responsibility?

And as for cost, look at the horrific level of overhead implied by such a vast management superstructure.

Various models can provide competitively-priced care. Although health care presents some special problems in catering compassionately to the indigent, the profit motive sure works well to hold down the price of most services I purchase. When coupons arrive in the mail, besides the usual ones for pizza places, limo services and home improvement services, there are sometimes lowball introductory offers from dentists -- one of the less-regulated fields of health care.

However, although I receive glossy brochures from area hospitals touting their quality and services, NEVER BUT NEVER are there any discount coupons, special package offers, or indeed, any mention of price whatsoever. In my state, for-profit hospitals aren't allowed; hospitals are run as a state-managed, capacity-controlled cartel. Most of their revenue comes from third-party payers (government, insurance companies). So of course, they don't compete on price. Like doctors and defense contractors, they operate on a 'cost-plus' basis. And costs only go up.

For this reason, the 'bureaucrat's wet dream' organizational chart of Obamacare guarantees that costs will spiral out of control as quality relentlessly degrades, while rationing increases. Whether one favors pure competition or universal care, the current mixed-to-mush model ensures a steady degradation of every measure of performance. 'Customer satisfaction' is not even a criterion in this tangled nightmare. The customers are just raw meat to be processed in the Obamacare abattoir, with the compassion of the IRS and the efficiency of the post office.

And Kongress thinks imposing 1099 filing requirements on all businesses is going to pay for it all.

If California wants to have state healthcare, there is nothing stoping it. After all Obama care is very similar to Massachusetts state run healthcare, except it is forced on the whole country.

For me, either we live in a constitutional republic with limited federal governmental powers, or we live in totalitarian system where the states and municipalities are little more than vassals of federal power. I want the former but it sounds like you and most people in Washington DC want the later.

Well that first part sounds fine by me. We here in CA have lots of experince with state madated insurance coverage of all types. Just don't ask us to balance your budget for you, some $23 billion short last count.

We have this wacky idea here that all businesses must have Workmans Compensation insurance for all employees. This is mandated, you can go to jail if you don't have it and someone gets hurt on the job. The state provides an insurance fund as an alternate to the private sector, and surprise surprise the private sector seems to coexist just fine with the state owned/sponsored fund. We put an insurance commissioner in place, companies are supposed to go through him to get rate increases. After a rocky start, workmans compensation premiums have dropped by about 1/3 over the last 5 years or so. You have to know how corrupt and full of abuse it was before the state stepped in to really appreciate the wonders of the "free" insurance market. Why do you suppose those totalitarian brown shirts imposed this wicked regime on hapless business owners? Won't the free market ultimately "entice" recalcitrant businesses to pony up the workman's comp premiums? I mean it's simple market economics right, either "choose" to insure or get sued for an on the job injury.

What business would fail to make the right choice here?

I guess it's all in the perspective. If you are an employer and are writing the check for health care premiums every month for many employees perhaps its all just a little less surreal than if the premiums are paid for you by an employer. Especially when rates are rising by 20%-40% every year.

So to the idea of states making this call- sounds great to me. But if my competition moves out of state to get around a local mandate for insurance coverage, do I have to move too? Or if they just incorporate in Nevada for example, do I do that as well? Or should I just drop the coverage that I have given to my employees (and their families) for 23 years, since the first day the doors opended?

Or how about we just ship the whole labor pool offshore, and layoff those pesky workers. Now who pays the healthcare bills when they can't get work and the COBRA extension expires.

And as for that choice, constitutional republic or totalitarian state. Since when did requiring people and corporations to pay their own costs to support their families and pursue their business models become such an affront to the constituition?

Hey I am with you on limiting governmental powers and authoritarian rule. Except when it makes things worse.

It’s not clear that you understand that the State of California is currently doing ALL of the things mentioned in both of our posts with respect to auto insurance, with no deleterious effects.

I live in California also. The State does none of the five points I outlined.

It does not currently require non-drivers (#1) to have auto insurance. To claim that it does is just plain ludicrous.

Neither have I ever heard of the State offering to sell auto insurance on the open market. Can you show me where it does this? If not, then clearly they are not competing with insurance companies as you claim. What the State does is pool high risk drivers and force them onto the rolls of insurance companies as a condition of doing business in the state. That's not the same as selling insurance. Not even close.

If the state gives free auto insurance (like Obamacare does with health insurance) to drivers unwilling and unable to buy their own insurance (point #4), then please tell me where I can sign on to that! I'd love that free ride. (Note: this is not the same as taking on high risk drivers who are uninsurable. Those drivers are still paying their insurance, just not at a rate that reflects their risk level.)

You claim that:

....provides a (for pay) compliance level policy for those whose driving records prohibit them from seeking the lower cost private option. At no cost to the tax payer.

This is what makes the analogy a cripple; Obamacare is going to cost the taxpayer plenty. Moreover, there are many who will pay nothing. That's the point of the whole exercise regarding the public option. Also, this claim reinforces point #5 in my post because if the State is not paying for this subsidy, then who is. Obviously it is the responsible people who drive carefully and then are charged a higher rate. This is a form of taxation (and socialism) although a cowardly one, inasmuch that it allows corruptocrats to tax without leaving their fingerprints.

If you don’t drive or have an auto, why must the analogy consider these non actors as contributors to the system?

Your analogy must consider this because that's what Obamacare does. If your analogy of auto insurance doesn't mimic Obamacare then your analogy falters. My case is a perfect example of this. In regards to health care, I am a non actor. I am 53 years old in perfect health, have only one time in my life had a serious health issue (knee surgery thirty two years ago), haven't been to the doctor since then (except for the "rubber glove' treatment at the insistance of my wife) and yet, I, a non-actor as you call it, must now buy into "the system" in order to subsidize those who live unhealthy lifestyles. For your analogy to hold, a non actor such as a healthy person must be excluded or be allowed to opt out, or somehow be able to escape the system, just like a non-driver can. Obamacare does not permit this, thus your analogy is a corpse.

People can avoid buying auto insurance. The very young and very old do so. Those who use public transportation, and college students who live in dorms for example can also evade the burden. The State has the right to impose conditions on the use of it's facilities and we can accept those conditions or opt out of using the facilities. But what Obamacare does is sets a condition upon one's citizenship, it taxes one's existance. In a sane world this would clearly be unconstitutional.

I think you missed the point of my original post. It was not to debate health care. I think it's a stinker and you, well, I don't know what you think because you say you don't support it but you seem to defend it. Whatever. My point in all of this was to address the nonsequiter of the analogy to auto insurance.

I’ve made the case that non drivers (non actors in may parlance) are not required to have auto insurance. I’ve also made the case that ALL drivers are mandated to have auto insurance, and that they must pay for this coverage. Not the state.

A minor child that does not drive and cannot create any situation where some lump sum damage claim (automotive related) occurs so they are not and should not be forced into any system. You cannot make that claim about health care, in fact the opposite claim can be made, at some point, you absolutely will require health care. So all are actors.

I am comparing the concept of an enlarged pool of (mandated) health care insured citizens with the same case for drivers in CA. I am not comparing Obamacare with auto insurance. These are your words, not mine. I am making a general analogy between mandated auto and health insurance.

The are some logical differences between car insurance and health insurance. But there are surprisingly few logical differences between mandated large population health care insurance pools and the large population car insurance pools. Let’s examine exactly what they are (and are not). With car insurance, you don’t drive you don’t pay. I think I made this point abundantly clear in my posts. In health care, we do not have this logical distinction, because everyone needs health care. Everyone, no exceptions. And no one wants to pay for it, or at least they want to defer it until they absolutely require it. No one wants to pay for car insurance either, until the wreck. This is fine, except we have to understand the mechanics of insurance, and this is based predominantly on the size of the insured population, and secondly, on relationship between premiums (inflows) and payouts (outflows).

Your contention that you are a non actor with respect to health care is absolutely wrong.

So wouldn’t it be great if we just got car insurance the day after the accident? You did not need it until the accident, so non actor right? No pesky premiums to pay, after all, you have a perfectly “healthy” car, why should you pay anything? Same thing with health care. Why pay if you’re healthy- you don’t need it. Heck, let’s get our wives to buy life insurance the day after we die, everything else is a waste.

You pay it because the aggregate premium distribution over your life amortizes the lump sum costs that DO occur. The premium level is determined by actuarial tables, age, risk factors, etc, and (here it comes) the number of people in the insurance pool. Fewer people, higher prices. Without this mechanism there can be no affordable insurance. If the total population pool in California was 100 drivers, neither of us could afford insurance.

It is not that I am not “allowing” someone to opt out in my analogy, it is that all are actors and all must pay- one way or the other. The correct comparison might be to have a driver in CA post an insurance bond rather than buy insurance. (I believe this is legal) The person is in effect saying, I don’t want any part of your system, I’ll take my chances. Fair enough, and both systems should allow this.

So the theory is that by enlarging the pool the costs can be driven down. Whether this actually occurs is anybody’s guess. But I can see a case (please not an Obamacare case) where the reduced rates lower costs for everyone. And conversely, if people refuse to participate, the population diminishes and then the rates go up. So in fact, I am subsidizing a person who does not feel he or she needs insurance, healthy or not.

Sorry if I seem to be piling on here, but once again you've got your facts wrong when you say:

The state provides an insurance fund as an alternate to the private sector, and surprise surprise the private sector seems to coexist just fine with the state owned/sponsored fund.

It's an easy misunderstanding to make; lots of people do. What I believe you refer to is the State Compensation Insurance Fund. As a small business owner, I have placed my workers compensation policy there. It is, however, despite it's title, not a State run organization. It is a private corporation. I know because I've asked. It's a private corporation.

This seems to gut your arguement that state sponsored insurance can, surprise surprise, coexist with private insurance. I have yet to see an example of this.

Also,this is misleading:

After a rocky start, workmans compensation premiums have dropped by about 1/3 over the last 5 years or so.

These rates dropped back to normal after briefly spiking some years back to exhorbitant levels. So in actuality over the long haul, rates haven't really dropped.

Thanks for the clarification. As far as I know, the State Compensation Insurance fund is state subsidized. I used to be with them as well, I switched to a broker that put me with Hartford, the rates are much lower than the State Fund.

All of the rate reductions I have seen has been with carriers other than the fund you mention.

Established in 1914 by the state legislature, State Fund is California’s largest provider of workers’ compensation insurance and a vital asset to California businesses. State Fund supports California’s entrepreneurial spirit and plays a stabilizing role in California’s economy by maintaining an open door policy ensuring all employers have a strong and stable option for their workers’ compensation needs.

I don’t contend that Obamacare is the solution, but I can’t help thinking that if words like “Orwellian” “totalitarian” and “socialism” were used a little less frequently, and certain groups a little more cognizant of the accelerating realities of health care costs, we might have ended up with something a little more analogous to the insurance solution in CA- without all the taxes.

The 10th Amendment states....

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

If California wants to have state healthcare, there is nothing stoping it. After all Obama care is very similar to Massachusetts state run healthcare, except it is forced on the whole country.

For me, either we live in a constitutional republic with limited federal governmental powers, or we live in totalitarian system where the states and municipalities are little more than vassals of federal power. I want the former but it sounds like you and most people in Washington DC want the later.

Sorry goes but we already are living in a totalitarian state, Have you read the Patriot Act? Flown lately? Checked a book out of the library? Checked to see if your name is on the red list or the blue list? Heard about American citizens being targeted for assassination? Ever heard of Jose Padilla? How about he FISA courts? How about all that news coverage of the Gulf oil spew? Maybe the bailouts?

Nah we live in a Constitutional Republic and I checked my brain at the border when I swam across the river.

Sorry goes but we already are living in a totalitarian state, Have you read the Patriot Act? Flown lately? Checked a book out of the library? Checked to see if your name is on the red list or the blue list? Heard about American citizens being targeted for assassination? Ever heard of Jose Padilla? How about he FISA courts? How about all that news coverage of the Gulf oil spew? Maybe the bailouts?

V,

I agree but I don't think that most Americans do, at least not yet. The Feds don't generally want the average citizen to think about those types of things because if citizens did it would bring into question the whole Federal governments legitimacy. Also it has been shown that people are far more productive when they at least have the illusion of autonomy. If the population awakens and realizes that they have no autonomy because they actually do live in a totalitarian state, with many of the attributes they were raised to believe are evil, they will be less productive as they loose faith in the system and start to disconnect. We might be witnessing the beginning steps of that now.

None are more hopelessly enslaved than those who falsely believe they are free. - Johann Goethe

So wouldn’t it be great if we just got car insurance the day after the accident? You did not need it until the accident, so non actor right? No pesky premiums to pay, after all, you have a perfectly “healthy” car, why should you pay anything? Same thing with health care. Why pay if you’re healthy- you don’t need it. Heck, let’s get our wives to buy life insurance the day after we die, everything else is a waste.

It is not that I am not “allowing” someone to opt out in my analogy, it is that all are actors and all must pay- one way or the other. The correct comparison might be to have a driver in CA post an insurance bond rather than buy insurance. (I believe this is legal) The person is in effect saying, I don’t want any part of your system, I’ll take my chances. Fair enough, and both systems should allow this.

So the theory is that by enlarging the pool the costs can be driven down. Whether this actually occurs is anybody’s guess. But I can see a case (please not an Obamacare case) where the reduced rates lower costs for everyone. And conversely, if people refuse to participate, the population diminishes and then the rates go up. So in fact, I am subsidizing a person who does not feel he or she needs insurance, healthy or not.

Insurance is only useful for relatively rare, costly events. Auto accidents, house fires, and job-related injuries happen to only a small, predictable number of insureds each year. So it makes sense for everyone in a large pool to pay a small premium to avoid an unlikely, but heavy loss.

True health insurance would cover 'heroic measures' that are relatively rare. For instance (I'm just making up these numbers), if only 1 percent of the population incurs more than $25,000 in medical costs per year, then a major medical policy with a $25,000 deductible would be a reasonable type of insurance.

Most health plans today cover nearly all routine health expenses. This is not insurance, and it does not make any economic sense. The heavy administrative costs of such plans are a deadweight loss. We have these plans because during the wage controls of WW II, employers started offering fringe benefits such as health coverage to compete for labor. In other words, one market distortion (wage controls) led to another distortion (employment-linked health expense indemnity coverage, mislabeled as 'insurance').

Given laws which force emergency departments to provide care regardless of ability to pay, a case can be made for universal high-deductible insurance. Several years ago, someone I know with little net worth had a catastrophic accident, ran up $250,000 in hospital bills, then filed for bankruptcy. The hospital got stiffed for the full quarter million. If he'd had a $25,000 deductible insurance plan, the hospital at least would have collected $225,000 from insurance -- and he might not have filed for bankruptcy over a $25,000 obligation, where a reasonable payment plan could have been negotiated.

Unfortunately the US economy has been so warped by employer-provided health plans, and the deeply-embedded semantic confusion over what 'insurance' means, that it's difficult to even discuss what 'reform' and 'universal insurance' would mean. But entrenching the existing dysfunctional, Rube Goldberg system (as Obamacare does) ensures runaway costs, declining quality, and increasing rationing.

Most health plans today cover nearly all routine health expenses. This is not insurance, and it does not make any economic sense. The heavy administrative costs of such plans are a deadweight loss. We have these plans because during the wage controls of WW II, employers started offering fringe benefits such as health coverage to compete for labor. In other words, one market distortion (wage controls) led to another distortion (employment-linked health expense indemnity coverage, mislabeled as 'insurance').

Given laws which force emergency departments to provide care regardless of ability to pay, a case can be made for universal high-deductible insurance. Several years ago, someone I know with little net worth had a catastrophic accident, ran up $250,000 in hospital bills, then filed for bankruptcy. The hospital got stiffed for the full quarter million. If he'd had a $25,000 deductible insurance plan, the hospital at least would have collected $225,000 from insurance -- and he might not have filed for bankruptcy over a $25,000 obligation, where a reasonable payment plan could have been negotiated.

Unfortunately the US economy has been so warped by employer-provided health plans, and the deeply-embedded semantic confusion over what 'insurance' means, that it's difficult to even discuss what 'reform' and 'universal insurance' would mean. But entrenching the existing dysfunctional, Rube Goldberg system (as Obamacare does) ensures runaway costs, declining quality, and increasing rationing.

Obamacare is a pig in a poke. Kill it before it multiplies!

Well stated! I couldn't agree more. Unfortunately, Obamacare is more like a vampire and the American population doesn't seem to know how to use a wooden stake and can't afford any silver bullets.

Unfortunately the US economy has been so warped by employer-provided health plans, and the deeply-embedded semantic confusion over what 'insurance' means, that it's difficult to even discuss what 'reform' and 'universal insurance' would mean. But entrenching the existing dysfunctional, Rube Goldberg system (as Obamacare does) ensures runaway costs, declining quality, and increasing rationing.

You know that is an astute observation.

Indeed, company provided health care has become a compensation enticement, and this has in fact has been lost in the translation. I would support a universal proposal that offered some type of mandated health insurance based on the principal of limited liability and high deductibles.

This assuages my complaint of so called healthy citizens externalizing catastrophic costs on the rest of us who must absorb these expenses in the form of higher taxes. I have a strong objection to this, especially when it is wrapped up in terms like patriotism, totalitarianism, and forced socialism.

Not to keep bringing up an unpopular analogy, but this is similar to the auto insurance situation in CA wherein minimal liability insurance is mandated, and some type of compliance based coverage is sponsored by the state for those that are either:

Neither of these state sponsored programs costs the taxpayer, but incremental costs are (nominally) rolled into the net cost of mainstream policy holders. Contrary to other assertions on this thread, this is in fact an equitable way of distributing these nominal costs to those that are “actors” in the system. To distribute theses costs as a tax is patently unfair, because there is a component of the tax base that does not use the services (does not drive) and they should not be charged for something they do not use.

Those that wish additional coverage, for example comprehensive and collision, must buy it on their own through the free market system, neither state program provides any relief here (nor should it). Noteworthy is the sheer size of the driver pool, there are 22 million licensed drivers in the state, and all are mandated to have insurance.

The same is true of the workman’s compensation insurance, this is mandated as well for all businesses. The state also provides a mechanism for compliance in the form of the state chartered State Compensation Fund. The mechanics of this are different then the auto insurance construct, as in the case of auto insurance the state is not a provider of services, rather, obligates other private carriers to provide coverage to both aforementioned programs. Regarding car insurance, the recipient does not have any supplier choice, the provider is assigned randomly. The state stipulates however, that the coverage is provided at cost, which is borne entirely by the recipient. Although technically the state does not “sell” or provide anything, they have in fact created a form of privatization in a clever and useful way, as they deliberately do not create an infrastructure to administrate these high risk or low income cases, they simply leverage the private sector and stipulate cost controls.

The workman’s compensation system is different. State Fund although privately owned is state chartered, and restricted to providing services at cost. This entity is the largest player in the CA workman’s compensation landscape, and has a large infrastructure to administrate the state mandated services. Another differentiator, there is no liability limit to a claim, and there is no deductible. Readers may find the near 100 year timeline history of this organization of interest.

In both cases, despite the incessant claims of “state advantage” the private sector competition is vibrant and robust, with consumers having direct input into quality levels. Customer service and customer satisfaction is an important feature of both type insurance carriers for those using the private sector option.

Despite the preference of many to paint this scenario with the indelible impression of a heavy jackboot, these systems work very well, and do so with very high population counts. In fact, these systems are “settled policy” and I honestly doubt you would find many residents who object to this system, or at the least, wish to change it in any material fashion.

In thinking about it, I can’t really recall any of the half dozen or so insurance policies that I have (business and personal) that are NOT mandated. The only exception (in my case) is health care. Consider:

- General Liability insurance, (business) mandated by office landlord, also by clients.

- E&O insurance, (business) mandated by clients.

- Boat insurance, mandated by lender.

If one is to ponder this irony and perhaps overlay with one’s own experience, a requirement for universal minimum liability mandated health care coverage makes a great deal of sense. Despite the logic and proven track record of similar large population insurance pools as demonstrated in California, the angry rhetoric and ideological blindness of the real issue as to who (and how much) is currently footing the bill will likely remain unchanged.

As District Judge Henry E. Hudson's preliminary ruling in the Virginia case makes clear, the constitutional question won't be easy to answer. The Supreme Court ruled in 1944 that the insurance business was a form of interstate commerce subject to federal regulation. But Cuccinelli pointed out several potential constitutional problems with the way Congress asserted its regulatory power in the new healthcare law, Hudson said. According to Hudson, all of these issues "seem to distill to the single question of whether or not Congress has the power to regulate — and tax — a citizen's decision not to participate in interstate commerce." That's a novel inquiry that Hudson rightly said merits a full hearing.

Yet Hudson's preliminary ruling overlooked a unique feature of the U.S. healthcare system: the fact that no one can effectively withdraw from it or avoid its costs. Federal law bars anyone from being denied emergency medical care, regardless of their ability to pay.Meanwhile, the healthcare system is riddled with cost-shifting — taxpayers pay much of the cost of Medicaid, and insured and self-funded patients subsidize the care received by those with Medicaid, Medicare or insufficient insurance coverage. And insurers have actively tried to push the costliest patients onto the public's tab by denying or rescinding coverage for those with preexisting conditions.

In that respect, health insurance is unlike virtually all other consumer products. Americans are affected by its influence over the healthcare system even if they don't have policies. The new law tries to make the system function more rationally by requiring insurers to offer coverage to everyone, regardless of past illnesses or injuries. But this requirement could encourage people not to obtain insurance until they needed expensive treatment, leaving insurers with the costliest customers and forcing premiums to rise even faster. The individual mandate deters people from gaming the system in this fashion. That's why it's an essential part of the law's insurance reforms and not an arbitrary intrusion into an individual's ability to tend to his or her own interests.

In thinking about it, I can’t really recall any of the half dozen or so insurance policies that I have (business and personal) that are NOT mandated. The only exception (in my case) is health care. Consider:

- General Liability insurance, (business) mandated by office landlord, also by clients.

- E&O insurance, (business) mandated by clients.

- Boat insurance, mandated by lender.

Of those listed, 4 out of 5 are examples you give are of something that are MANDATED by the owner of the thing, not the government. If you are own your own home, and want to self insure, I doubt there is any thing they can do to force you to buy insurance. Anyways, my issue is with the Federal government, not the sovereign states which can retain the rights to mandate certain types of insurance.

As long as the states have to compete regulatorily, things are not likely to get out of hand, at least not quickly. Once it is FORCED by the FEDs, there is no escape for anybody.

As District Judge Henry E. Hudson's preliminary ruling in the Virginia case makes clear, the constitutional question won't be easy to answer. The Supreme Court ruled in 1944 that the insurance business was a form of interstate commerce subject to federal regulation. But Cuccinelli pointed out several potential constitutional problems with the way Congress asserted its regulatory power in the new healthcare law, Hudson said. According to Hudson, all of these issues "seem to distill to the single question of whether or not Congress has the power to regulate — and tax — a citizen's decision not to participate in interstate commerce." That's a novel inquiry that Hudson rightly said merits a full hearing.

Yet Hudson's preliminary ruling overlooked a unique feature of the U.S. healthcare system: the fact that no one can effectively withdraw from it or avoid its costs. Federal law bars anyone from being denied emergency medical care, regardless of their ability to pay.Meanwhile, the healthcare system is riddled with cost-shifting — taxpayers pay much of the cost of Medicaid, and insured and self-funded patients subsidize the care received by those with Medicaid, Medicare or insufficient insurance coverage. And insurers have actively tried to push the costliest patients onto the public's tab by denying or rescinding coverage for those with preexisting conditions.

In that respect, health insurance is unlike virtually all other consumer products. Americans are affected by its influence over the healthcare system even if they don't have policies. The new law tries to make the system function more rationally by requiring insurers to offer coverage to everyone, regardless of past illnesses or injuries. But this requirement could encourage people not to obtain insurance until they needed expensive treatment, leaving insurers with the costliest customers and forcing premiums to rise even faster. The individual mandate deters people from gaming the system in this fashion. That's why it's an essential part of the law's insurance reforms and not an arbitrary intrusion into an individual's ability to tend to his or her own interests.

Anyways, my issue is with the Federal government, not the sovereign states which can retain the rights to mandate certain types of insurance.

As long as the states have to compete regulatorily, things are not likely to get out of hand, at least not quickly. Once it is FORCED by the FEDs, there is no escape for anybody.

Charles Bukowski once said: “The only difference between a democracy and a dictatorship is that in a democracy you vote first and take orders later, and in a dictatorship you don’t waste your time voting”

I rather like his succinct way of refusing to acknowledge differences in authority and political structure.

If “We the People” were to own a building and become a landlord, “We the People” would require the tenants to have insurance prior to taking possession, just like any landlord, in order to eliminate any possibility of transfer of liability to us. So would any other landlord removing the possibility (except of course in internet discussions) of moving from building to building- or state to state to avoid the requirement.

If “We the People” were to make a bank loan and the loan recipient were to use the funds to buy a house or a car, “We the People” would force the loan recipient to have insurance as a contingency to the loan. So would any other bank again removing the possibility of shopping for an institution that did not require insurance.

I find it ironic that in most cases exposing principals to any significant liability, appropriate insurance is ALWAYS mandated by the principal, governmental or otherwise. This is of course to prevent the recipient from exposing the principal to a capital loss. A capital loss that would be in effect externalized by the recipient and transferred to the principal. The requirement of this is mandatory. The cost is born by the recipient.

But not healthcare. Unlimited exposure, unlimited dollar amounts, population counts in excess of 300 MM people, no insurance, no problem.

Noteworthy is the sheer size of the driver pool, there are 22 million licensed drivers in the state, and all are mandated to have insurance.

The same is true of the workman’s compensation insurance, this is mandated as well for all businesses.

<snip>

So why is it then that not all drivers have car insurance? Why is it that not all contractor's/companies have workman's comp?

The enforcement of these statutes gives rise to yet another expensive and ineffective government bureaurcracy. More government means more taxes and more government spending. We have too much government now.

edit: We (Calif) are 20 billion in the hole now because we have too much government. A government that passes laws and then needs to find a way to raise taxes to pay for it.

Noteworthy is the sheer size of the driver pool, there are 22 million licensed drivers in the state, and all are mandated to have insurance.

The same is true of the workman’s compensation insurance, this is mandated as well for all businesses.

<snip>

So why is it then that not all drivers have car insurance? Why is it that not all contractor's/companies have workman's comp?

The enforcement of these statutes gives rise to yet another expensive and ineffective government bureaurcracy. More government means more taxes and more government spending. We have too much government now.

edit: We (Calif) are 20 billion in the hole now because we have too much government. A government that passes laws and then needs to find a way to raise taxes to pay for it.

Your question is regarding compliance. It is not 100%, and never will be. This is not justification for erasing the advances of the mandated insurance requirements.

What kind of a healthcare system would you expect when the insurance companies are allowed to dictate and write the program. It's the same thing as what happened with the financial reform bill, not a real overhaul but simply window dressing on a thoroughly corrupt system. And the same goes for any sector you look at since they are the ones that bankroll the political class. It's called regulatory capture and it defines our entire government. Can't change anything until the whole damn thing comes crashing down. Concentration of wealth and power = inequality and corruption.

I find it ironic that in most cases exposing principals to any significant liability, appropriate insurance is ALWAYS mandated by the principal, governmental or otherwise. This is of course to prevent the recipient from exposing the principal to a capital loss. A capital loss that would be in effect externalized by the recipient and transferred to the principal. The requirement of this is mandatory. The cost is born by the recipient.

But not healthcare. Unlimited exposure, unlimited dollar amounts, population counts in excess of 300 MM people, no insurance, no problem.

Funny no?

Nothing is wrong with this logic, per se. But there are alternatives.

Here is one, which has some historical precedent -- in-kind services for the indigent in community clinics and charity hospitals. There might be some de facto rationing, some questions about quality. But no one would be denied care for lack of ability to pay.

Those who could pay likely would be able to afford routine care in a more competitive market. My middle-class family paid our own doctor bills when I was kid, including some specialist care. Those who chose to go without catastrophic insurance would do so, knowing that heroic measures such as liver transplants might not be available in the local charity hospital.

Does this sound too Darwinian? I would much prefer it over our current system, where health 'insurance' (with all its costly state-mandated coverages) is breathtakingly costly, and anyone seeking to pay their own way for care faces institutionalized price discrimination.

If I were facing a major medical issue, my instinct would be to leave the country for Mexico, Costa Rica, Brazil ... places where you can actually get a reasonable, lump sum quote for getting patched up. The fat, dumb and lazy cost-plus health care cartel, which exists solely by dint of political rent-seeking, makes me so angry that it would inhibit my recovery. Ergo, gotta go!

Delusional citizen: “Cheetos are health food. They’re organic. That’s why they have that color. And look, the beer I drink says ‘Lite’ right on it. Exercise? Do you have any idea how hard it is to get out of a bean-bag chair? Besides, I watch ESPN.”

“Medicine will fix me. Medicine is magic.”

“More medicine is better. Since it’s all so confusing that it’s hard to know what to choose, we can take ‘more expensive’ as a proper marker for ‘more.’” (Some studies actually show that drugs work better when patients believe they are more expensive.)

“I have a right not only to good, strong, proper, quality health care, I have a right to just plain more health care. No, I’d rather not give up smoking or super-size nachos, thank you very much, but look, I’m into recreational stents. And order me up some new hips, new eyes, heck, give me knees that will let me get into skydiving and tae kwan do. While you’re at it, make me young!”

“Of course, somebody should pay for all this, but it should not be someone of my class, age, BMI, hair color, something, in any case, not me or people like me.”

Delusional state government: “Hospitals and doctors are a bunch of whiners. Look at those huge budgets—in most localities, the biggest employer is the hospital. We can carve out more and more, and they can just adjust.”

“What do they mean, there is no care for the poor? They get it at the ER. Hospitals need to just suck it up.” (To pick one example from a wealth of them, Minnesota’s governor, Tim Pawlentey, recently completely de-funded the state’s general assistance medical care for the poorest of the poor. The legislature relented and put the funding back in—at 7 cents on the dollar. Many hospitals are declining the payment as not even being worth the paperwork.)

Delusional politician: “All those countries that the experts tell us do health care for half our cost and get better results are a bunch of socialists. Nothing to learn there.” (One politician suggested that we go back to a barter system: Bring the doctor some chickens; paint the doctor’s house. I couldn’t make up stuff like this if I tried.)

“Besides, we have the best health care system in the world.”

Delusional hospital: “Dodged that bullet. Whew!”

“We don’t really have to do anything different, do we? A few adjustments around the edges, that’s all we need.” (Hospital exec to me: “Nah, we’re not going to do that digitization stuff. We looked into it, and the stimulus incentives are less than it would cost us. We’re not stupid, you know.”)

Delusional hospital employee: “At least my job is safe. I don’t have to worry. We’ve got a union, there are regulations, this place has plenty of inertia, they need people like me.”

“Management is always coming up with the buzzword of the week—‘lean’ management, quality this and that. We just outlast ’em.”

Delusional doctor: “Hey, I’m a doctor. I’m a good doctor. The country needs doctors. To be specific, it needs my kind of doctor, doing the kind of procedure I’m all set up to do here in my private center. The one that brings me an excellent living, actually.”

“Of course, I send all the ones that can’t pay enough over to the hospital. I’m not a charity, you know, and they are. That’s their business.”

“Don’t give me this stuff about how the hospital has to charge more because they’ve got that emergency department and all the non-pays and all that. They just don’t know how to run their business. Not my problem.”

“No, I never even go over to the hospital anymore. That’s why they have those hospitalists and intensivists.”

“Take call? I don’t think so.”

“No, I don’t have to pay any attention to those studies that claim to show that aspirin, yoga and dropping a few pounds can do the same job as my procedure for one-hundredth the price. This is America, this is a free enterprise system, and no one has the right to tell me that I can’t do whatever procedure that I deem medically necessary, and get paid for it by the government.”

“Guidelines? I don’t have to do it that way; that’s not the way I do it.”

Delusional pharmaceutical company: “Dodged that bullet. Washington knows that there’s blood in the water if they try anything like imposing prices on us.”

“This is a business, and we pay attention to business: The stock price, the ROI, and the quarterly reports. You want charity? Go talk to one.”

Delusional health plan: “We can work this. We’ve got more lawyers working HHS than there are feathers in Vegas.”

“There’s loads of gray area in that reform act. And you can bet we’ll find every hole in it.

“Here’s one: Can’t drop someone’s coverage for having a pre-existing condition anymore, right? But we certainly don’t have to cover someone if they don’t take care of themselves, like if they don’t take their medicine, their statins or whatever that would keep them out of the hospital. Then we tell them that they have to buy their pharmaceuticals online, or by mail, and outsource that part to a company who is world-class at making it insanely difficult to do, especially for the elderly sorts. Bingo! One more excuse to drop people. You didn’t take your medicine, now did you?

“Besides, the bit in the law that says, ‘No rescissions’ also says, ‘except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage.’ Hoo boy, you have no idea how much fraud is out there, and intentional misrepresentations up the wazoo! One guy listed his birthplace as Van Nuys, Calif., when his birth certificate was signed by a doctor at a hospital 2 miles away in Panorama City. Talk about fraud!

“Anyway, we can just stay out of those exchanges until they cry uncle and soften the regulations. We don’t need that market under those conditions. They need us.”

Noteworthy is the sheer size of the driver pool, there are 22 million licensed drivers in the state, and all are mandated to have insurance.

The same is true of the workman’s compensation insurance, this is mandated as well for all businesses.

<snip>

So why is it then that not all drivers have car insurance? Why is it that not all contractor's/companies have workman's comp?

The enforcement of these statutes gives rise to yet another expensive and ineffective government bureaurcracy. More government means more taxes and more government spending. We have too much government now.

edit: We (Calif) are 20 billion in the hole now because we have too much government. A government that passes laws and then needs to find a way to raise taxes to pay for it.

Your question is regarding compliance. It is not 100%, and never will be. This is not justification for erasing the advances of the mandated insurance requirements.

No - the point is that when the gov. passes a law " thou shalt comply" then they have to provide some sort of enforcement of the law which then requires more gov and more taxes.